Bestuurssamenstelling

Bestuursleden:

Voorzitter: Sanne de Zwaan

Secretaris: Veronique Vorstenbosch

Penningmeester: vacature staat open

Hoofdlijnen beleidsplan

Werkzaamheden van de Stichting

De doelstelling van de stichting is het wereldwijd verbeteren van de moeder en/ of kinderzorg in de breedste zin van het woord

De stichting tracht dit doel te bereiken door de volgende werkzaamheden:

• het vergroten van de beschikbare kennis op dit terrein door het steunen van wetenschappelijk onderzoek
• het verbreiden van kennis door het geven van voorlichting aan de bevolking als ook aan medische en paramedische groepen, door scholing, nascholing, publicaties en andere daartoe strekkende middelen
• het vervullen van actieve, initierende coordinerende en stimulerende rol bij het streven naar verbetering van het raamwerk waarin preventie, behandeling en nazorg bij moeder- en kindzorg plaatshebben
• nauwe samenwerking met hulpverlening aan organisaties met vrijwilligers uit de bevolking en professionele groepen, die deze doelstelling tot hun taak rekenen en daarvoor in aanmerking komen.

Het vermogen van de stichting

Het vermogen van de stichting wordt momenteel gevormd door fondswerving

Het Noorse Laerdal Foundation for Acute Medicine heeft een beurs ter beschikking gesteld ter waarde van 240.000 dollar aan de stichting Safe Motherhood. Jaarlijks zal er, mits voldoende progressie, 80.000 dollar door Laerdal worden overgemaakt aan de Stichting. Voor de specifieke voorwaarden kan Laerdal letter grant 1 en 2 ter inzage voorgelegd worden. 

Dit vermogen kan eventueel aangevuld worden door middel van

• schenkingen, subsidies, erfstellingen en legaten
• de opbrengsten van haar activiteiten
• de opbrengst van het vermogen zelf

Het beheer, de besteding en de uitkering van het vermogen

De stichting zal een boekhouding bijhouden. Voor de boekhouding geldt dat een boekjaar gelijk is aan een kalenderjaar. Binnen 6 maanden na afloop van elk boekjaar zal het bestuur de jaarrekening van het afgelopen jaar vaststellen. Deze jaarrekening omvat een balans, en staat van ontvangsten en uitgaven en een toelichting op deze stukken. Tevens zal deze jaarrekening gecontroleerd worden door een register- accountant of een andere door het bestuur aangewezen deskundige.

Helping Mothers Deliver in Tanzania 2012

Progress report of “Helping Mothers Deliver – an assessment of the quality of obstetric care and a prospective study of the impact of simulation-based training in emergency obstetric care in a resource-limited rural hospital in Tanzania”.

Introduction

In summary my research project is about the evaluation of the simulation-based training “Helping Mothers Survive - Bleeding After Birth” (HMS-BAB) that will be given in Haydom Lutheran Hospital (HLH). The evaluation will be based on the four levels of Kirkpatrick. The first level is reaction: how do people value the simulation-based training? Participants of the training will be assessed by means of an evaluation form immediately after the course. The second level is learning: How do the participants change their knowledge, skills and attitude after training compared to before training? This will be assessed by a knowledge and skills test and an attitude questionnaire before, immediately after and at six months after training. The third level is behaviour: How do people change their behaviour in daily practice with the newly acquired knowledge and skills? This will be assessed by prospective observations of all deliveries that take place in HLH during 6 months before intervention and 6 months after intervention. The last level that will be addressed is the outcome: How does training affect the outcome of the mother? This will be assessed by both the prospective observations, but also by the maternal morbidity and mortality data that is collected in the hospital since November 2009.

Activities of 2012

February 2012:

Visit to Stavanger: preparation of field visit March 2012.

March 2012:

Field visit Tanzania: Intervention with Helping Mothers Survive simulation-based training. Pre- and post testing of knowledge, skills and confidence.

April 2012:

Conference Safe Motherhood, Amsterdam: oral presentation about maternal morbidity and mortality in a rural hospital in Tanzania.

May 2012:

MCHIP Conference, Bangladesh: oral presentation about intervention with Helping Mothers Survive simulation-based training with preliminary results of pre- and post testing of knowledge, skills and confidence.

June 2012:

Conference SESAM, Stavanger: oral presentation about intervention with Helping Mothers Survive simulation-based training with results of pre- and post testing of knowledge, skills and confidence.

July 2012:

-        Field visit Tanzania: Follow-up maternal morbidity and mortality data collection, training research assistants. Informal inquiries about implementation of low-dose high frequency (LDHF) implementation of Helping Mothers Survive.

-        Submission article “Maternal Near Miss and Mortality in a Rural Referral Hospital in Northern Tanzania: a Cross Sectional Study” to BJOG. Rejected after review in September 2012.

October 2012:

-        FIGO Conference, Rome: oral presentation about validity of WHO near miss criteria, poster presentation about intervention with Helping Mothers Survive simulation-based training with results of pre- and post testing of knowledge, skills and confidence.

-        Field visit to Tanzania (Oct-Dec 2012): 6-month post intervention testing of retention of knowledge and skills of health care workers. Follow-up of data collection maternal morbidity and mortality data. Training of research assistants.

November 2012:

Submission article “Maternal Near Miss and Mortality in a Rural Referral Hospital in Northern Tanzania: a Cross Sectional Study” to BMC Pregnancy and Childbirth. Article is currently under revision.

December 2012:

Submission article “Applicability of the WHO Maternal Near Miss Criteria in a Low-Resource Setting” to PLOS one. Article is currently under revision.

Planning 2013

-        March-August: implementation study HLH. Why did implementation of LDHF training not succeed and how can we improve implementation of LDHF training? This side project will be designed by Ellen Nelissen, Jacqueline Broerse and Marleen van Overstraten, and carried out by Marleen van Overstraten in Tanzania.

-        March: Submission of paper about level 1 and 2 evaluation

-        March: Field visit Tanzania for implementation study and follow up of maternal morbidity and mortality data collection.

-        April: Conference gynaecology & obstetrics, Rotterdam: oral presentation validity WHO near miss criteria.

-        June: Submission paper about level 3 “behaviour change” after simulation-based training.

-        June: SESAM conference Paris

-        Aug: Submission paper retention of knowledge and skills after simulation-based training.

-        Oct: Submission paper about level 4 “maternal outcome” after simulation-based training.

-        Nov/Dec: writing of PhD-thesis

-        Dec: Submission paper about implementation of LDHF training.

Helping Mothers Deliver in Tanzania 2011

Progress report of “Helping Mothers Deliver – an assessment of the quality of obstetric care and a prospective study of the impact of simulation-based training in emergency obstetric care in a resource-limited rural hospital in Tanzania”.

Introduction

First of all, I would like to thank you for supporting me and my research project in Tanzania. Without your financial support it wouldn’t have been possible to conduct this very relevant research in saving the lives of mothers in Tanzania, but also worldwide. This report is to give you an overview of the activities that I have undertaken to reach the pre-defined goals.

To refresh your memory, in summary my research project is about the evaluation of the simulation-based training “Helping Mothers Survive - Bleeding After Birth” (HMS-BAB) that will be given in Haydom Lutheran Hospital (HLH). The evaluation will be based on the four levels of Kirkpatrick. The first level is reaction: how do people value the simulation-based training? Participants of the training will be assessed by means of an evaluation form immediately after the course. The second level is learning: How do the participants change their knowledge, skills and attitude after training compared to before training? This will be assessed by a knowledge and skills test and an attitude questionnaire before, immediately after and at six months after training. The third level is behaviour: How do people change their behaviour in daily practice with the newly acquired knowledge and skills? This will be assessed by prospective observations of all deliveries that take place in HLH during 6 months before intervention and 6 months after intervention. The last level that will be addressed is the outcome: How does training affect the outcome of the mother? This will be assessed by both the prospective observations, but also by the maternal morbidity and mortality data that is collected in the hospital since November 2009.

Progress of research

In the past year I have done a literature review of the available literature concerning maternal morbidity and mortality on a global scale and simulation based medical education. Furthermore I attended courses in “Introduction in clinical research and biostatistics for clinicians” and “Principles of epidemiologic data-analysis”. I visited two conferences; in February I went to the Africa Regional Meeting on Interventions for Impact in Essential Obstetric and Newborn Care in Addis Ababa and in June I went to the ICM conference in Durban. Both were very valuable for connecting with key persons involved with MamaNatalie and Helping Mother Survive from Lærdal and Jhpiego.

As stated in the research proposal as you have received it in October last year, I have been able to continue with the collection of maternal near miss and maternal death cases. This November we accomplished two years of registration and we will continue at least another two years. Furthermore I have been preparing data collection tools with Hege Langli Ersdal and Doris Østergaard for the simulation-based training with Mama Natalie that is coming up in collaboration.

NIMR clearance

One of the first aims of 2011 was to achieve IRB clearance from the National Institute for Medical Research (NIMR). Unfortunately our application got lost twice and I submitted the application again in November 2011 in person. We have received the research clearance certificate from NIMR on 29-12-2011.

Field visits to Tanzania

In 2011 I completed four field visits to Haydom Lutheran Hospital (HLH).

In February 2011 I assessed the quality of data collection for the maternal near miss and death registration. I also assessed the data that was being collected regarding maternal complications by the research assistants in labour ward. We decided that the data collection tool for registering maternal complication needed improvement and also the research assistants needed additional training.

In May 2011 I visited HLH again and introduced the new data collection tool for registering maternal complications. The research assistants, who have finished secondary school form 4, were trained in two days on how to fill in the form. I was assisted by a Tanzanian intern who also translated the forms and an explanation on how to fill in the form in Swahili. On 25-05-2011 we started with the baseline data collection regarding maternal complications in labour ward.

My third visit to HLH was in August 2011 that is when I also met the full board of the Lærdal Foundation. We had a very valuable day in which we showed the board members around the hospital and also presented preliminary results and progress of the research. During that visit I also retrained the research assistants and assessed the quality of the maternal morbidity and mortality data that was collected in the previous three months.

During my last visit to Tanzania in November and December, I resubmitted our proposal to NIMR, retrained the research assistants, did quality assessment of the maternal morbidity and mortality data and had several meetings with the hospital management to create a platform to improve the quality of obstetric care and to make people aware of the upcoming training of Helping Mothers Survive – Bleeding After Birth. Especially the last meeting was also used to involve the health care workers and management in the preparation of the training in an interactive way.

Challenges

Our first aim was to give the initial training in HLH in July 2009. Early 2011 we noticed that this would be to soon because the curriculum of HMS-BAB was not finished yet, so we delayed the intervention to November 2011. In November 2011 we encountered another problem; the IRB clearance for the training was lost for the second time at the NIMR head quarters. The goal will now be that the initial training will be given in January or February 2012, depending on Jhpiego personnel to be available for teaching. That means that the assessments of level 2 will take place in January/February 2012 and the 6-month post training evaluation 6 months after the initial training.

Planned activities for 2012

Jan: finalization of first article about two years of maternal morbidity and mortality in a rural referral hospital in Tanzania and an evaluation of the maternal near miss approach, this article will be submitted to BJOG.

Jan/Feb: Intervention with simulation based training course HMS-BAB in HLH, assessment of level 1 and 2

Mar: Stakeholder meeting HMS-BAB

Mar/Apr: Data-analysis of level 1 and 2. Write second article about the evaluation of level 1 and 2

Apr: 20-4-12: presentation of two years of maternal morbidity and mortality in a rural referral hospital in Tanzania and an evaluation of the maternal near miss approach at NVTG symposium, Amsterdam.

Jun: SESAM conference Stavanger, an abstract about the evaluation of level 1 and 2 will be submitted for presentation.

Aug/Sep: 6-month evaluation level 2

Sep/Oct: Data-analysis of level 1, 2 and 3. Write third article about the evaluation of level 1, 2 and 3.

Oct: FIGO world congress, Rome. Two abstracts will be submitted for presentation. The first abstract will be about two years of maternal morbidity and mortality in a rural referral hospital in Tanzania and an evaluation of the maternal near miss approach. The second abstract will be about the evaluation of level 1, 2 and 3.

Conclusion

Overall, the research project goes very well, especially considering this research is taking place in a low-income country. All credits go to E. Mduma, the research manager and the research assistants working in Maternity Ward of HLH. The data collection is in place, the quality of the data is guaranteed. We only have encountered some delay in the intervention, but that will not harm the goal of disseminate the results in 2012 and 2013. I still expect to finish my thesis and defend my PhD by the end of 2013.